Mammen Suraj, Krishna Satheesh, Quon Matthew, Shabana Wael M, Hakim Shaheed W, Flood Trevor A, Schieda Nicola
J Comput Assist Tomogr. 2018 Mar/Apr;42(2):204-210. doi: 10.1097/RCT.0000000000000664.
The aim of this study was to compare grade and stage of upper tract urothelial cell carcinoma (UCC) using computed tomography.
With institutional review board approval, 48 patients with 49 UCC (44 high grade and 5 low grade, 26 ≤ T1 and 23 ≥ T2) underwent nephroureterectomy and preoperative computed tomography between 2013 and 2015. Two blinded radiologists assessed for tumor appearance (filling defect/mass or wall thickening/stricture), margin (smooth or spiculated/irregular), texture (homogeneous, heterogeneous), hydronephrosis, and calcification. A third blinded radiologist established consensus. A fourth blinded radiologist measured size and first-order histogram texture features. Comparisons were performed using χ test, multivariable logistic regression, and receiver operator characteristic analysis.
There was no difference in size of tumors compared by grade or stage (P = 0.80 and 0.13, respectively).Among subjective variables, only tumor texture was significantly different between low- and high-grade UCC (P = 0.03; κ = 0.45). Tumors characterized as spiculated/irregular margin (P = 0.003; 0.30) and heterogeneous (P < 0.001; κ = 0.45) were associated with T2 disease or higher.Entropy was greater in higher grade (6.23 ± 0.46 vs 5.72 ± 0.28) and T2 disease or higher (6.40 ± 0.33 vs 5.95 ± 0.48), (P = 0.03 and 0.02, respectively) with no differences in Kurtosis or Skewness (P > 0.05). Area under the receiver operator characteristic curve for entropy to diagnose high-grade and T2 tumors or higher was 0.83 (confidence interval, 0.64-1.0) and 0.79 (confidence interval 0.59-0.98), respectively.
Heterogeneity, assessed qualitatively and quantitatively, is accurate for diagnosis of higher grade and stage of disease in upper tract UCC. Spiculated/irregular margins are also associated with T2 disease or higher.
本研究旨在利用计算机断层扫描比较上尿路尿路上皮癌（UCC）的分级和分期。
经机构审查委员会批准，2013年至2015年间，48例患有49处UCC（44例高级别和5例低级别，26例≤T1且23例≥T2）的患者接受了肾输尿管切除术及术前计算机断层扫描。两名不知情的放射科医生评估肿瘤表现（充盈缺损/肿块或壁增厚/狭窄）、边缘（光滑或毛刺状/不规则）、质地（均匀、不均匀）、肾积水和钙化情况。第三名不知情的放射科医生确定共识。第四名不知情的放射科医生测量肿瘤大小和一阶直方图纹理特征。采用χ检验、多变量逻辑回归和受试者操作特征分析进行比较。
按分级或分期比较，肿瘤大小无差异（P值分别为0.80和0.13）。在主观变量中，低级别和高级别UCC之间仅肿瘤质地存在显著差异（P = 0.03；κ = 0.45）。表现为毛刺状/不规则边缘（P = 0.003；0.30）和不均匀（P < 0.001；κ = 0.45）的肿瘤与T2期或更高分期疾病相关。熵在高级别（6.23±0.46对5.72±0.28）和T2期或更高分期疾病（6.40±0.33对5.95±0.48）中更大（P值分别为0.03和0.02），峰度或偏度无差异（P > 0.05）。熵用于诊断高级别和T2期或更高分期肿瘤的受试者操作特征曲线下面积分别为0.83（置信区间，0.64 - 1.0）和0.79（置信区间0.59 - 0.98）。
定性和定量评估的不均匀性对上尿路UCC疾病的高级别和分期诊断准确。毛刺状/不规则边缘也与T2期或更高分期疾病相关。
